There, is a high incidence of overuse injuries among manual wheelchair users. One method to prevent the development or delay the onset of injuries is to reduce the physical demand on the user during wheelchair propulsion. Configuration of the wheelchair can have a significant effect on the effort required to propel the wheelchair; however, the optimal setup required to minimize demand on the user is not known. The goal of this project is to develop the OptiFit system, a clinical tool for determining the optimal wheelchair configuration for a specific user. The wheelchair configuration variables that most influence propulsion ergonomics will be determined through a series of studies involving manual wheelchair users. The primary variables to be investigated include: shoulder-to-hub distance, shoulder-to-hub angle, seat angle, back support angle, back support height, wheel camber, and wheel diameter. Propulsion efficiency will be evaluated with respect to user characteristics, such as arm length, range of shoulder extension, and upper extremity strength. The algorithm for the OptiFit system will be developed based on statistical correlations between subject characteristics and propulsion outcome measures. Use of the OptiFit system in clinical settings will assist rehabilitation professionals in providing wheelchairs that are optimally configured for each user. Maximizing propulsion ergonomics through an optimal wheelchair setup will likely reduce the incidence and severity of overuse injuries.